Retraction: End-of-life discontinuation of destination therapy with cardiac and ventilatory support medical devices: physician-assisted death or allowing the patient to die?
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
Learn more about PhilPapers
BMC Medical Ethics 11 (1):20- (2010)
BackgroundBioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die."DiscussionAdvances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used for permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death.SummaryDestination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
No citations found.
Similar books and articles
David Shaw (2007). The Body as Unwarranted Life Support: A New Perspective on Euthanasia. Journal of Medical Ethics 33 (9):519-521.
Thomas S. Huddle (2013). Moral Fiction or Moral Fact? The Distinction Between Doing and Allowing in Medical Ethics. Bioethics 27 (5):257-262.
Aaron G. Rizzieri, Joseph L. Verheijde, Mohamed Y. Rady & Joan L. McGregor (2008). Ethical Challenges with the Left Ventricular Assist Device as a Destination Therapy. Philosophy, Ethics, and Humanities in Medicine 3 (1):1-15.
Thomas S. Huddle & F. Amos Bailey (2012). Pacemaker Deactivation: Withdrawal of Support or Active Ending of Life? Theoretical Medicine and Bioethics 33 (6):421-433.
Michael S. Jastremski (1984). Death and Dying: Reflections of an Intensivist. Theoretical Medicine and Bioethics 5 (2).
Timothy F. Murphy (2011). A Philosophical Obituary: Dr. Jack Kevorkian Dead at 83 Leaving End of Life Debate in the US Forever Changed. American Journal of Bioethics 11 (7):3 - 6.
Jukka Varelius (2012). Ending Life, Morality, and Meaning. Ethical Theory and Moral Practice 16 (3):559-574.
Martin Gunderson (1993). Physician Assisted Death and Hard Choices. Journal of Medicine and Philosophy 18 (3):329-341.
Richard Momeyer (1995). Does Physician Assisted Suicide Violate the Integrity of Medicine? Journal of Medicine and Philosophy 20 (1):13-24.
Tito B. Carvalho, Mohamed Y. Rady, Joseph L. Verheijde & Jason Scott Robert (2011). Continuous Deep Sedation in End-of-Life Care: Disentangling Palliation From Physician-Assisted Death. American Journal of Bioethics 11 (6):60 - 62.
Manne Sjöstrand, Gert Helgesson, Stefan Eriksson & Niklas Juth (2013). Autonomy-Based Arguments Against Physician-Assisted Suicide and Euthanasia: A Critique. [REVIEW] Medicine, Health Care and Philosophy 16 (2):225-230.
Helga Kuhse (1987). The Sanctity-of-Life Doctrine in Medicine: A Critique. Oxford University Press.
M. Pabst Battin (2005). Ending Life: Ethics and the Way We Die. Oxford University Press.
Y. Michael Barilan (2003). Revisiting the Problem of Jewish Bioethics: The Case of Terminal Care. Kennedy Institute of Ethics Journal 13 (2):141-168.
Andrew Sneddon (2006). Equality, Justice, and Paternalism: Recentreing Debate About Physician-Assisted Suicide. Journal of Applied Philosophy 23 (4):387–404.
Added to index2010-08-24
Total downloads13 ( #170,095 of 1,696,258 )
Recent downloads (6 months)3 ( #177,943 of 1,696,258 )
How can I increase my downloads?